Senior Credentialing Specialist

Job Summary

To support the credentialing process for healthcare providers, the full-time Senior Credentialing Specialist will coordinate all activities related to the credentialing and re-credentialing of physicians, ensuring compliance with organizational and regulatory standards in a hybrid work environment.

Key responsibilities

• Implement and monitor procedures for credentialing, re-credentialing, and privileging of network providers
• Process provider applications and maintain the provider profiling system, ensuring high-quality standards are met
• Lead training initiatives for less experienced specialists and conduct regular file audits

Required qualifications

• Associate's degree preferred
• Three years of credentialing experience in a managed care plan, Medical Staff Services, or credentialing verification office
• Strong understanding of Joint Commission, NCQA, and URAC accreditation standards
• Advanced knowledge in payer enrollment, including Medicare and Medicaid
• Proficient in Microsoft Office, especially Word and Excel